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. 2018 Oct 11;11(1):717.
doi: 10.1186/s13104-018-3822-7.

Poliovirus excretion following vaccination with live poliovirus vaccine in patients with primary immunodeficiency disorders: clinicians' perspectives in the endgame plan for polio eradication

Nermeen M Galal  1 , Safaa Meshaal  2 , Rabab ElHawary  2 , Eman Nasr  3 , Laila Bassiouni  3 , Humayun Ashghar  4 , Noha H Farag  5 , Ondrej Mach  4 , Cara Burns  5 , Jane Iber  5 , Qi Chen  5 , Aisha ElMarsafy  6
Affiliations

Poliovirus excretion following vaccination with live poliovirus vaccine in patients with primary immunodeficiency disorders: clinicians' perspectives in the endgame plan for polio eradication

Nermeen M Galal et al. BMC Res Notes. .

Abstract

Objective: Primary immunodeficiency (PID) patients are prone to developing viral infections and should not be vaccinated with live vaccines. In such patients, prolonged excretion and viral divergence may occur and they may subsequently act as reservoirs in the community introducing mutated virus and jeopardizing polio eradication. One hundred and thirty PID cases were included for poliovirus detection in stool with assessment of divergence of detected polioviruses from oral polio vaccine (OPV) virus. Clinical presentations of PID patients with detectable poliovirus in stool specimens are described.

Results: Six PID patients (4.5%) had detectable vaccine-derived poliovirus (VDPV) excretion in stool specimens; of these, five patients had severe combined immunodeficiency (two with acute flaccid paralysis, one with meningoencephalitis and two without neurological manifestations), and one patient had X-linked agammaglobulinemia (paralysis developed shortly after diagnosis of immunodeficiency). All six case-patients received trivalent OPV. Five case-patients had type 2 immunodeficiency-related vaccine-derived polioviruses (iVDPV2) excretion; one had concomitant excretion of Sabin like type 3 virus and one was identified as iVDPV1 excretor. Surveillance for poliovirus excretion among PID patients is critical as these patients represent a potential source to reseed polioviruses into populations.

Keywords: Immunodeficiency; Polio eradication; Virus excretion.

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Figures

Fig. 1
Fig. 1
Detection of vaccine-derived poliovirus among patients with suspected or confirmed primary immunodeficiency (PID) disorders diagnosed at Cairo University Immunology Center, Egypt, 2011–2017. PID primary immune deficiency, SCID severe combined immunodeficiency, XLA X-linked agammaglobulinemia, AFP acute flaccid paralysis. *Patients presented with acute flaccid paralysis (AFP), were screened for poliovirus excretion and referred to Cairo University Immunology Center for PID screening. Seventh patient excreted SL3, no VDPV was isolated
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